Healthcare Provider Details

I. General information

NPI: 1386377802
Provider Name (Legal Business Name): HANNA BETH JEFSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 GOLF VISTA PLAZA SUITE 340
LEESBURGH VA
20176-8272
US

IV. Provider business mailing address

19441 GOLF VISTA PLAZA SUITE 340
LEESBURGH VA
20176-8272
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9527
  • Fax: 703-723-4475
Mailing address:
  • Phone: 703-723-9527
  • Fax: 703-723-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: